Background In spite of recent improvements in the outcomes of preterm infants, sepsis remains to be an important cause of mortality and morbidity. Studies have noted the rise of Gram-negative infections as causes of sepsis in the preterm population.
Objectives We aim to describe the epidemiology, trends and microbial distribution of neonatal sepsis episodes among preterm infants born <32 weeks gestation over a 13-year period.
Methods This is a retrospective single-centre cohort study of culture-confirmed neonatal sepsis episodes, which is defined as the isolation of pathogenic organism from blood and/or cerebrospinal fluid cultures. We included newborns that were admitted to the Neonatal Intensive Care Unit (NICU) who were < 32 weeks birth gestation and birthweight of ≤1500 g. Neonatal sepsis episodes were stratified into early-onset sepsis (EOS) occurring at <72 hours of birth and late-onset sepsis (LOS) occurring >72 hours after birth up till discharge.
Results A total of 2019 preterm infants were included in the study. The characteristics of the cohort: 52.7% male, median birth gestational age 28 weeks, 19.9% small-for-gestational age, 89.9% received antenatal steroids, 85.5% had a central venous catheter. Over the study period, 263 infants had a total of 273 episodes of culture-confirmed sepsis –49 EOS and 224 LOS episodes. Incidence of sepsis in this cohort decreased from a high of 24.2% in 2006 to 7.4% in 2017. This was concordant with a decrease in LOS over the same period: 16.8%-21.6% from 2005–2006 to 4.9% in 2017. EOS incidence remained relatively stable, ranging from 0–4.4%. Gram negative bacteria were the predominant pathogen group isolated, accounting for 186/281 (66.2%) of all organisms– 40/49 (81.6%) of EOS and 146/224 (65.2%) of LOS episodes. E Coli [24/49 (49.0%)] and Klebsiella spp [39/224 (17.4%)] were the most common microbial causes of EOS and LOS episodes respectively. Coagulase negative staphylococcus (CONS) accounted for 36/224 (16.1%) of LOS. Fungal infections were predominantly due to Candida spp - 12.1% (27/224) of LOS. Of note, there were no fungal infections detected over the recent 5 years.
Conclusions The decrease in the overall incidence of neonatal sepsis among preterm infants <32 weeks in our centre over the 13-year study period, is due to a reduction in LOS. Gram-negative bacterial organisms are the predominant infecting organism in this population with E.Coli and Klebsiella spp being the most common causes of EOS and LOS.
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